Oncology & Hematology Coding Alert

Stay alert to units and admin method for these updated non-chemotherapy HCPCS codes.

The changes to HCPCS 2013, effective January 1, answer the call for codes that describe newly available drugs, new options for administration, and a need for consistency in calculating units. Here are four areas to watch.

J1569 Is Now OK for Sub-Q Admin

Immune globulin codes will see some minor revisions for 2013.

J1561: The first change is the deletion of the outdated brand name Gamunex from J1561:

• 2012: J1561, Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), non-lyophilized (e.g. liquid), 500 mg
• 2013: J1561, Injection, immune globulin, (Gamunex-C/Gammaked), non-lyophilized (e.g., liquid), 500 mg.

J1569: The second change removes the term intravenous from Gammagard Liquid code J1569:

• 2012: J1569, Injection, immune globulin, (Gammagard Liquid), intravenous, non-lyophilized, (e.g., liquid), 500 mg
• 2013: J1569, Injection, immune globulin, (Gammagard Liquid), non-lyophilized, (e.g., liquid), 500 mg.

The revision ensures that J1569 use is not limited to intravenous Gammagard Liquid. In particular, the code can now apply to subcutaneously administered Gammagard Liquid, as well.

J7178 Completes the Fibrinogen Transition

HCPCS 2013 deletes two human fibrinogen concentrate codes:

• J1680, Injection, human fibrinogen concentrate, 100 mg
• Q2045, Injection, human fibrinogen concentrate, 1 mg.

Medicare stopped paying for J1680 in July, replacing it with temporary code Q2045. The difference between the two codes is the per unit amount: 100 mg/unit for J1680 and 1 mg/unit for Q2045.

Effective January 1, you have new code J7178 (Injection, human fibrinogen concentrate, 1 mg). The addition places this code with the other clotting factor codes and acts to "standardize the ‘unit’ definition among the various clotting factors at 1 mg," according to the May 8, 2012, HCPCS Public Meeting Summary Report (available from the Downloads section of www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/HCPCSPublicMeetings.html).

Quantity alert: Take note of the large unit difference between J1680, at 100 mg per unit, and J7178, at 1 mg per unit, especially if you were still reporting J1680 to some payers at the end of 2012. For example:

If the dose of J1680 was 3,780 mg, the reported units would have been 38 (rounding up for an increment less than a whole unit)

For the same dose (3,780 mg) but using J7178, the reported units will be 3780.

Be sure to adjust your code for 2013 and, if needed, notify internal staff that new code J7178 will have a much different dose/quantity calculation for billing compared to J1680.

Look to J1741 for IV Ibuprofen

The code for intravenous ibuprofen has moved from a temporary hospital-outpatient C-code into the realm of the J codes in 2013.

Deletion/addition: HCPCS 2013 deletes C9279 (Injection, ibuprofen, 100 mg) and adds J1741 (Injection, ibuprofen, 100 mg).

IV ibuprofen is sold under the brand name Caldolor. The drug is available in 400 mg/4 ml single-dose vials or in 800 mg/8 ml single-dose vials. The physician may order IV ibuprofen to manage pain or reduce fever.

Watch Units for Relistor

HCPCS 2013 has added a new code for Relistor, which is used to treat patients with opioid-induced constipation: J2212 (Injection, methylnaltrexone, 0. 1 mg).

Unit calculations could be a trouble spot for this code. The initial code request suggested that a single unit should represent up to 12 mg. This amount falls in line with the recommended dose of Relistor, which "is 8mg for patients weighing 38 kg to less than 62 kg (82 lb to less than 136 lb) or 12 mg for patients weighing 62 kg to 114 kg (136 lb to 251 lb)," the Summary states.

Instead, the code definition indicates each 0.1 mg represents a single unit. To calculate units, you should divide the amount administered by 0.1. So for a 12 mg dose, divide 12 by 0.1 for a total of 120 units.

Resource: The complete HCPCS 2013 list is available from www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html.